# 1095-C Form

URL: https://pdf.net/pdf-forms/tax-forms/1095-c-form
Category: Tax Forms
Attributes: Official IRS form, Trusted by healthcare pros, Filled annually

1095-C Form is a tax form issued by Applicable Large Employers (ALEs) to inform their employees and the IRS about the employer-provided health insurance offer and coverage.

Open our fillable 1095-C Form in our PDF editor and enter the required information without a hassle. Afterward, you can download the document to your device or print it out to send it by mail.

## Versions

- 2025 — [download PDF](https://cdn.sanity.io/files/i16te7yp/production/b02af05c76c29cbaf0b426e16c7192b22608510f.pdf)

## How to Fill Out an I-765 Form

Step 1: Open our IRS Form 1095-C in PDF.

Step 2: Enter information about the employee and the employer.

Step 3: Fill out the employer offer of coverage table for the entire year, as specified in Form 1095-C instructions.

Step 4: Complete Part III of the form if the ALE Member offers employer-sponsored, self-insured health coverage.

Step 5: Review the information and download Form 1095-C to your device.

Step 6: Prepare the accompanying Form 1094-C.

## Facts

### What Is Form 1095-C?

Form 1095-C, also known as Employer-Provided Health Insurance Offer and Coverage, is a document detailing information about the health coverage offered to eligible employees.

### Who Is Required to File Form 1095-C?

All Applicable Large Employers (ALEs) are required to file Form 1095-C with the IRS and issue a copy to each eligible employee. ALEs are companies and organizations with at least 50 full-time employees or full-time employee equivalents.

### When Is Form 1095-C Due for Submission?

Form 1095-C is due for submission by the end of February if filed on paper or the end of March if sent electronically. If the due date falls on a weekend or a legal holiday, then it’s pushed to the following business day.

### What Are the Penalties for Not Submitting Form 1095-C?

Under the Affordable Care Act, ALEs are required to file Form 1095-C with the IRS and furnish it to employees, and failure to do so may result in a fine. This penalty is adjusted for inflation each year, but it’s currently $340 per form.

### Where Do I File Form 1095-C?

You should file Form 1095-C with the IRS, either by mail to one of the addresses provided on their website or electronically. If you are filing 10 or more forms in a year, you are required to submit them electronically.

## Related forms

- [Form 1095-B](https://pdf.net/pdf-forms/tax-forms/form-1095-b)
- [Form 1094-C](https://pdf.net/pdf-forms/tax-forms/form-1094-c)
- [1040 Form](https://pdf.net/pdf-forms/tax-forms/1040-form)
- [Form 8962](https://pdf.net/pdf-forms/tax-forms/8962-form)
- [Schedule A (Form 1040)](https://pdf.net/pdf-forms/tax-forms/schedule-a-form-1040)